Group Benefits Administrative Update

Transcription

1 Group Benefits Administrative Update Imptant infmation f Plan Administrats First Quarter 2002 Welcome This is Manulife Financial s first quarter 2002 Administrative Update. Each quarter we send infmation on coverage changes, process improvements, legislative news, other issues that require the immediate attention of plan administrats. This quarter s edition includes infmation about B.C. government Pharmacare and Medical Services Plan changes, a reminder about the Montreal Group Benefits Service Centre, and background infmation about Evidence of Insurability. Please keep this issue of Administrative Update on file with your contract f future reference. The Administrative Update is provided to share infmation with Policy Administrats. It is not intended as advice. Although we strive f accuracy, we are only bringing summaries highlights to your attention. Please refer to your Group Policy f complete terms and conditions. If there is a discrepancy between our communications and the Group Policy, the terms of the policy will apply. British Columbia government announces coverage and rate changes f some medical services The British Columbia government changed its rates and coverage f paramedical practitioners and Pharmacare, January, The exclusion of some previously covered services will leave group benefits plans responsible f amounts no longer funded by the province. Coverage changes The government no longer pays the first $300 f paramedical visits, and private health plan members will submit these claims to their private insurance plans. Plans offering paramedical coverage will now pay f these claims up to existing paramedical plan limits. Previously, private plans were not permitted to pay any of the first $300 amount. Group Benefits Administrative Update First Quarter 2002

2 F Pharmacare, larger deductible amounts and prescription fees will also mean me claims will be submitted to private health care plans f payment. Rate changes We reviewed all Group Benefit plans with a majity of plan members residing in B.C. to determine if an immediate rate increase would be required. If your plan required a rate increase, you should have already received a letter describing the specific impact on your plan. F reference, the changes to the B.C. Medical Services Plan are summarized in the infmation sheet attached to this Update. F me infmation about this change and how it will affect you, please contact your Benefit Plan Advis your Manulife Financial representative. Montreal Group Benefits Customer Service Centre: New voice technology is now in place In December, Manulife Financial introduced new technology in the Montreal Group Benefits Customer Service Centre. All calls from coast to coast receive the same treatment and are logged on to the same system, regardless of whether they are handled in Waterloo Montreal. Interactive Voice Response (IVR) allows fast-tracking With Interactive Voice Response (IVR) technology, plan administrats and members can easily get infmation about health and dental coverages and claims payments. Callers can fast track through the IVR by pressing a combination of options one after the other. F example pressing,,and (with sht pauses between each selection) allows callers to quickly select English as the language, plan administrat as the caller and Dental as the benefit, and then enter the plan number and member ID. This saves callers listening to the complete introduction, which they may not need. Extended service hours IVR access is available Monday to Friday, 7 a.m. to 9 p.m. Eastern time, and Saturdays 7:30 a.m. until 4:30 p.m. Customer Service Representatives are still available During regular business hours, callers can still transfer to a Customer Service Representative once appropriate plan/group number and plan member I.D./Certificate number have been entered. When the call transfers, the CSR will immediately see the relevant customer infmation from the IVR, saving time f the caller. 2 Group Benefits Administrative Update First Quarter 2002

3 Call Flow diagram This new technology presents a convenient way f customers to get their Health and Dental claims and coverage infmation. Attached to this edition of Administrative Update is a sample of the call flow f plan administrats. Call flow diagrams are available in 25-sheet notepads (GC0205E and GC0205F). Member brochures explaining the Group Benefits Customer Service Centre are also available in English French. GL3472 outlines the call flow f plan members. These materials may be dered using the Group Benefits materials reder fm available on-line by going to and clicking on Fms and Administration Fms. Questions and Answers: late applicants, medical underwriting riting and Evidence of Insurability Most of the time, Group Health plan members don't have to pass a medical examination take any special tests to qualify f insurance coverage under the group plan. Occasionally, Plan Member Administration area asks f Evidence of Insurability. In some cases, other medical infmation may be required. Some level of Evidence of Insurability medical underwriting is required f the majity of Alpha Plus groups. When does an Evidence of Insurability fm have to be completed? Groups generally have a non-evidence limit in their contracts. Every member can get coverage to that limit without providing any medical evidence. When Benefit amounts are salary-based, if a member s salary qualifies f an amount of Life and/ Long-Term Disability benefit volume that is over the non-evidence limit, the member must complete an Evidence of Insurability fm. When the plan member and/ dependants have not applied f benefits within the time outlined in their contract, these applicants are considered "late" and are required to submit an Evidence of Insurability fm. Most contracts with Employee Optional and Spousal Optional Life Benefits require a completed Evidence of Insurability fm. An exception may be when Optional Life is transferred from a pri carrier. What other fms are required with the Evidence of Insurability? With applications f Employee Optional Life and/ Spousal Optional Life, an Optional Life application fm a cover letter outlining the coverage being requested is required. The cover letter must include the benefits being applied f, the volume of coverage accding to the contract, and the plan member dependant's name. The cover letter is most likely to be used by plan sponss of self-administered plans. 3 Group Benefits Administrative Update First Quarter 2002

4 What is a late applicant? In a "late applicant" situation, Manulife Financial requires the Application f Enrolment/Reinstatement Change fm. Please include the crect plan number and account/division number(s) on each fm. Employees may be considered as Late Applicants if: They apply f coverage under the Group Benefit Program later than the limitation in the contract (e.g. 3 days after the date on which they and/ dependants are first eligible), OR They refuse cancel coverage under the Group Benefit Program, then reapply at a later date. Why do we medically underwrite late applicants? With non-mandaty plans, the plan administrat asks employees about benefit coverage when they join the company. Some will say yes, others say no. If the employee says no at first and yes at a later date, that individual is considered a late applicant, and underwriting will screen the applicant. The applicant may have refused the insurance, then discovered a need f coverage related to an illness condition. Manulife may choose to gather additional infmation from the applicant's doct to see if there are any medical conditions. The medical underwriting area does this background wk to manage anti-selection risks and keep the cost of the plan reasonable f all employers and employees. What processes can plan administrats put into place to avoid late applicants? Use Internet enrolment Complete enrolment fms at employee ientation Send in new fms at the time a change occurs. Note: Evidence of Insurability fms are now available on Manulife Financial s public web site. Other fms can also be found there. Check at If you have questions, need me infmation about Evidence of Insurability medical underwriting, please contact your Manulife Financial representative. 4 Group Benefits Administrative Update First Quarter 2002

5 Imptant reminders Please complete and return your Blanket Purchase Exemption Certificate (Ontario Retail Sales Tax) Every year, group employers who do business in Ontario and employ residents of Ontario are asked to complete a Blanket Purchase Exemption Certificate (BPEC). The BPEC is used to determine if your group is eligible f an exemption from the 8% Ontario Retail Sales Tax on premiums charged f: Employees who are non-residents of Ontario and/ Employees who are Status-Indians living on a reserve. If you are eligible f this exemption, please complete the fm. (A copy is attached.) Be sure to sign and date it, include your group policy number and indicate whether the exemption does does not apply to your group. Completed BPEC fms can be returned by fax to GB Premium Administration (59) If you require another copy of the Blanket Purchase Exemption Certificate (fm GL2039B), a replacement can be dered using the Group Benefits Materials Reder fm available on-line by going to and clicking on Fms and Administration fms. Benefit from the convenience of pre-authized monthly premium payments Groups whose benefits are administered by Manulife Financial can enjoy the convenience of paying monthly premiums by pre-authized debit. Premiums will be automatically debited on the 0 th day of each month. It s a quick and easy way to eliminate the time and efft involved in the preparation of your monthly premium cheque. To sign up f pre-authized premium payments, simply contact your Manulife Financial representative. Need me infmation? F me infmation on how these changes reminders affect your group benefits plan, please contact your Manulife Financial representative. Please file this bulletin f future reference. To obtain additional copies of this any previous Administrative Update, please visit and click on Employee Benefit News. 5 Group Benefits Administrative Update First Quarter 2002

6 Administrative Update First Quarter 2002 Attachment Infmation sheet What are the changes in B.C. and why do they increase private health insurance costs? Paramedical services As of January, 2002, B.C. s Medical Services Plan (MSP) will no longer pay f physiotherapy, chiropractic, naturopath, podiatrist and massage therapy services f any British Columbia resident who is not entitled to premium assistance. Private plans will cover the full cost of all paramedical visits up to plan limits and maximums. F those who do qualify f assistance (net family income less than $20,000 per year) Medical Services Plan will pay $23 to the practitioner f the cost of each visit. Patients will have to pay an additional amount if the practitioner s fee is higher than the amount reimbursed by MSP. Prescription drugs Individuals under age 65 who are not eligible f government assistance will see their Pharmacare deductible rise from $800 to $000 per year. Individuals over age 65 who do not qualify f government assistance will pay up to $25 per prescription to a maximum of $275 a year. Befe January, 2002, these individuals were fully covered f prescription drugs and paid only dispensing fees to a maximum of $200 a year. Costs shift from government to private health plans Changes in B.C. s approach to coverage will leave group benefits plans responsible f amounts no longer funded by the province. When rates were last set, the amount funded by the province was used to project plan costs. Rates will now increase based on plan design to reflect the additional amounts paid f prescriptions and paramedical practitioners services. Currently, any plan member who qualifies f provincial assistance must reach the provincial maximum of 0 visits befe beginning to submit claims to Manulife Financial.

7 Group Benefits Customer Service Centre Answers at your fingertips When you have a group benefits inquiry dial your Group Benefits Customer Service Centre phone number. When your call is connected press f service in English then press to identify yourself as a plan administrat then press Plan member s name: Plan member ID/ certificate number: Purpose of call: Date: Group/plan number: f dental inquiries f health inquiries f disability inquiries You may be instructed to telephone a local office f claims office addresses f any other inquiries Notes then press the numerical digits of your plan number then press the plan member ID/ certificate number if you selected dental inquiries above, press f dental claim payments f pre-determination of dental benefit status f dependent coverage/dental fee guides f dental coverage inquiries (e.g. preventative, restative, etc.) if you selected health inquiries above, press f health claims infmation f maj medical coverage infmation (e.g. deductible, co-insurance, etc.) f drug coverage infmation f other health inquiries (e.g., hospital, vision, etc.) helpful hints At any time after making the first three selections, you may press * # 0 to return to the previous menu to repeat the infmation/instruction you just heard to transfer to a customer service representative during our Customer Service Centre s business hours If you are calling from a non-touch-tone phone, hold f a customer service representative. GC0205E (0/200) Manulife Financial and the block design are registered service marks and trademarks of The Manufacturers Life Insurance Company and are used by it and its affiliates including Manulife Financial Cpation.

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